Active NPI
Jeremy Randall Moffett
- Pharmacist
- Shreveport, LA
National Provider Identifier
1609161256
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 16563
- Practice address
- 7110 Youree Dr
Shreveport, LA 71105-5107 - Phone
- (318) 798-7860
- NPI assigned
- Jun 11, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 16563 | LA | Primary |
Addresses
Primary practice location
7110 Youree Dr
Shreveport, LA 71105-5107
Mailing address
151 Waters Edge Dr
Shreveport, LA 71106-7775
Phone (318) 798-6593
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16563 | LA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307750400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307750400000",
"number": "1609161256",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "151 WATERS EDGE DR",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711067775",
"telephone_number": "318-798-6593"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7110 YOUREE DR",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711055107",
"telephone_number": "318-798-7860"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOFFETT",
"first_name": "JEREMY",
"middle_name": "RANDALL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-11",
"last_updated": "2011-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "LA",
"license": "16563",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.